Child abuse and neglect is a public health problem and usually associated with family dysfunction due to multiple psychosocial, individual, and environmental factors. The diagnosis of child abuse may be difficult and require a high index of suspicion on the part of the practitioners encountering the child and the family.  There are four main types of abuse: neglect, physical abuse, psychological abuse, and sexual abuse. Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm. Child abuse and neglect that goes undiagnosed may give rise to chronic abuse and increased morbidity-mortality. Most of the fatal victims are young, more than two-thirds being under 3 years of age (most of them are boys) 80% of child fatalities were caused by one or both parent.
The majority of deaths are caused manually, either by 1- hitting or beating with the hands, 2- shaking, throwing, dropping and – less often – 3- by burning or Suffocation.
It is exceptional for death to be caused by the impact of a blunt instrument, though non-fatal bruises from beating with a strap, for instance, are sometimes seen.
Shooting, strangling and stabbing are characteristic of classical homicide, which is distinct from the child abuse syndrome.
Among the fatalities attributed to child abuse, the most common cause of death is injury to the head, followed by injury to the abdomen.
The extent of the problem
Fatal abuse
Information on the numbers of children who die each year as a result of abuse comes primarily from death registries or mortality data. According to the World Health Organization, there were an estimated 57 000 deaths attributed to homicide among children under 15 years of age. Global estimates of child homicide suggest that infants and very young children are at greatest risk, with rates for the 0–4-year-old age group more than double those of 5–14-year-olds 
The risk of fatal abuse for children varies according to the income level of a country and region of the World. For children under 5 years of age living in high-income countries, the rate of homicide is 2.2 per 100 000 for boys and 1.8 per 100 000 for girls. In low- to middle-income countries the rates are 2–3 times higher – 6.1 per 100 000 for boys and 5.1 per 100 000 for girls. The highest homicide rates for children under 5 years of age are found in the WHO African Region – 17.9 per 100 000 for boys and 12.7 per 100 000 for girls. The lowest rates are seen in high-income countries in the WHO European, Eastern Mediterranean and Western Pacific Regions.
Many child deaths, however, are not routinely investigated and postmortem examinations are not carried out, which makes it difficult to establish the precise number of fatalities from child abuse in any given country. Even in wealthy countries there are problems in properly recognizing cases of infanticide and measuring their incidence. Significant levels of misclassification in the cause of death as reported on death certificates have been found, for example, in several states of the United States of America. Deaths attributed to other causes – for instance, sudden infant death syndrome or accidents – have often been shown on reinvestigation to be homicides .
Despite the apparent widespread misclassification, there is general agreement that fatalities from child abuse are far more frequent than official records suggest in every country where studies of infant deaths have been undertaken.

Case # 1
A 1 year 10 months old girl arrived dead to the emergency department as case of sudden death as family reported that they find her dead in the bed.
 At autopsy, external examination revealed no sign of any type of injuries while internal examination revealed 500 ml of liquid blood and clotted blood on the abdominal cavity with pancreatic transection and superior mesenteric artery laceration and small bowel contusion.

Case #2
A 6 years-old boy (A. J.Q) arrived dead to the emergency department of a city hospital at 19.30 on a Tuesday 17.1.2017 evening by the distraught father, saying the boy had fallen from the stairs and was now unconscious and he did not know what to do. The boy was unconscious; a large scalp bruise was palpable, Raccoon eyes were seen at the emergency department.
Forensic Autopsy and post-mortem examination was conducted the next day and we show presence of parietal scalp bruising, and confirmed the presence of the large subdural hematoma, cerebral swelling, as well as the bilateral orbital hemorrhages. There were a couple of small yellow bruises on the knees and a yellowing bruise on the left forehead 2 cm in diameter. In particular, there were multiple wounds, scars, abrasions, contusions and burn scars in different parts of the body and it have different age time, no bone or ribs fractures.  

Case #3
Three-years-old girl was brought by ambulance to the emergency room of Surgical Hospital in Nablus, she was unconscious with sever hypotension, Bradycardia, Cold extremities, dilated Right pupil not respond to light. Swelling and redness in the left frontal part of the head. Urgently CT brain done and sent the child to surgical room where she was died during cranioctomy. 
At autopsy, external examination revealed multiple circular contusions on the hands and feet in same diameters around 1-1.5 cm and at the site of surgery there was a scalp wound in the right parietal region and cranioctomy where the dura at the same side opened and, brain tissue edematous and flattened, and there was an old fractures in the occipital bone which extended to foramen magnum and right parietal bone.
 

Conference Title

RAS Al kheimahs first international forensic science conference

Conference Country

United Arab Emirates

Conference Date

March 9, 2020 - March 11, 2020

Conference Sponsor

وزارة الداخلية ، القيادة العامة لشرطة راس الخيمة

Additional Info

Conference Website